ABSTRACT
Objective To investigate the effectiveness and safety of carbapenem antimicrobial management programs (ASP). Methods 671 patients who were discharged from the emergency department of the hospital from January 2017 to April 2018 were enrolled. These patients were subject to before-and-after self-control studies, using such intervention measures as MDT proactive management-feedback-training. January-September of 2017 was set as the pre-intervention stage, and September 2017-April 2018 as the post-intervention stage. The two stages were compared in such indicators as the monthly antibacterial use, quality of care and hospital acquired infection. Results Thanks to the ASP measure against antibiotics like carbapenems, the use rate of carbapenems at the emergency department ward fell from 36.7% to 18.6% , the defined drug doses (DDDs) of carbapenems fell from 211.92 to 82.22, and the antibiotics use density (AUD) of carbapenems fell from 29. 18 DDDs/100 day/patient to 11. 56. The pathogen detected rate increased significantly (0.61 ± 0.08 versus 0.78 ± 0.16), with a difference of statistical significance (P=0.020). On the other hand, the mean days of stay, average cost per hospitalization, proportion of antibiotics use, incidence of hospital acquired infections, and the infection/colonization rate of carbapenem-resistant organisms ( CROs ) present no significant changes. There was a moderate positive correlation between carbapenem DDDs and mean days of stay ( P=0.034), and also a moderate positive correlation between hospital acquired infection incidence and CROs infection/colonization rate ( r = 0.545, P = 0.029 ). Conclusions The carbapenem ASP at the hospital proves safe and effective. CROs infection/colonization may be the cause of hospital acquired infection. Prevention and control against multi-drug resistant bacteria on the basis of ASP may add to the effect of ASP.
ABSTRACT
Objective To evaluate the value of gelsolin for the prognosis of patients with severe sepsis.Methods 50 patients in the emergency intensive care unit of Beijing hospital from January 2015 to July 2015,were determined white blood cell count (WBC),C-reactive protein (CRP),procalcitonin (PCT),gelsolin at admission,acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score were estimated within 24 hours.According to the 28 days of survival outcome,50 patients were divided into two groups:survival group and death group.The significant difference of these factors was compared.Binary logistic regression analysis was applied for screening independent risk factors for the prediction of death.The receiver operating characteristic (ROC) curve was applied for the evaluation and comparison about prognosis ability.Results 31 patients were in the survival group,19 patients in the death group.The gelsolin [(21.43±10.54) vs.(13.31±8.54),P=0.007] andAPACHE Ⅱ score [(19.2±6.86) vs.(24.6 ± 8.9),P =0.021] in two groups had significance difference.Binary logistic regression analysis indicated that the gelsolin and APACHE Ⅱ score were independent risk factors of predicting death.The area under of ROC curve (AUC) of the gelsolin was 0.745 (95％ CI:0.599-0.851,P =0.004) and the APACHE Ⅱ score was 0.699 (95％ CI:0.537-0.862,P =0.019).Both prognosis ability were equivalent.To combine the tow factors,the accuracy of predition was 90％ and has better complementarity.Conclusions the gelsolin could assess the severity of patients with severe sepsis and predict the prognosis more accurately.
ABSTRACT
Objective To investigate clinical value of gelsoin level for evaluating severity and prognosis in patients with critical illness. Methods Forty-eight patients with critical illness admitted to the Emergency Intensive Care Unit of Beijing Hospital during February to December 2008 were enrolled in this study, with 23 survivors and 25 deaths. Serum level of gelsolin was measured for 31 of them at least twice during their hospital stay, and for other 17 only once at their admission. They all were evaluated with acute physiology and chronic health evaluation Ⅱ ( APACHE Ⅱ ) scores within 24 hours after admission. In addition, serum level of gelsolin was measured for another 307 healthy adults as controls. Results Initial level of gelsolin was significantly lower in 48 patients at critically ill than that in controls [(24 ± 11) mg/L vs. (192 ±39) mg/L, P < 0. 01]. There was significant difference in initial level of gelsolin between surviving group (23 cases) and death group (25 cases) [(28 ± 10) mg/L vs. (21 ±12) mg/L, P = 0. 033]. Fatality of patients at critically ill increased as their level of gelsolin at 22 mg/L or less, with a predicting accuracy of 74. 19% , as well as decreasing trend of their gelsolin levels in continuously minitoring, with a predicting accuracy of 70. 97%. Predicting accuracy of APACHE Ⅱ scores of 30 or more was 67.74%. However, predicting accuracy would reach 93.55% as final level of gelsolin and its decreasing trend combined with APACHE Ⅱ scores in prognostic assessment for critically ill patients. Conclusions Severity of patients at critically ill can be predicted by their gelsolin level, especially in continuously monitoring, which is an indicator better than APACHE Ⅱ scores. Combination of gelsolin level with APACHE Ⅱ scores shows a more accurate prognostic assessment for critically ill patients.